CARE OF PATIENTS WITH INTRAVENOUS THERAPY

Intravenous Therapy – the administration / introduction of fluids directly into the vein

Purposes / Rationale / Goals:

a. Maintain & replace body stores of water, electrolytes, vitamins, proteins, fate & calories
when patient or client cannot maintain an adequate intake by mouth
b. Restore acid-base balance
c. Restore volume of blood components
d. Provide avenue for the administration of medication
e. Provide nutrition while resting the GI Tract

Equipment Needed:

a. IV Fluid – in bottle or plastic container

b. Tubing
c. Needle / Catheter – in different sizes (gauge 14 – 25) or winged, “butterfly” needle
d. IV Pole / IV Infusion Pump
e. Others – dressing (transparent gauze); tape / plaster; splint / armboard

Advantages:

a. used when patient cannot take oral medication

b. permits accurate dose
c. acts instantly – absorbed quickly by the body

Disadvantages:

a. Carries risk like bleeding, infiltration, infection, and allergic reactions

b. Limits patient activities
c. Costly – costs more than any other drug

Adult contain 60% of fluids in the body

Functions of Fluid:

1. Intracellular – 55% of total body fluid

2. Extracellular – 45% of total body fluid
a. Interstitial Fluids
b. CSF – Cerebro Spinal Fluid
c. Plasma

Kinds of IV Solutions:
 1. Isotonic solution – has the same osmolarity as serum and other body fluids, hence, it
stays where it is infused (intravascular space). It expands this
compartment without pulling the fluid from other compartments
(intracellular & interstitial). Example: LR, NSS (0.9 NS). Indication:
Blood loss or hypovolemia

2. Hypertonic solution – osmolarity is higher than the serum. When infused, it initially
increases osmolarity causing the fluid to be pulled from the interstitial
& intracellular compartments into the blood vessel (intravascular
space). Example: D50.5NS, D5LR, D5NS. Indication: Regulate urine
output; stabilize blood pressure; reduce risk of edema; Post-op
Patients

3. Hypotonic solution – osmolarity is lower than the serum. When infused, fluid shifts out of
the blood vessels (intravascular space) into the cells while reducing
the fluid in circulatory system. Example: D0.45NS; 0.33NS; Dextrose
2.5% in Water. Indications: Dehydration; DKA; HHNK

Osmolarity – no. of particles in a Liter of Water

Osmolality – no. of particles per Kg. of Water

Crystalloid – clear IV fluid - Hypotonic

- Hypertonic

- Isotonic

Colloid – Murky / Black IV Fluid

Parts of IV Tubing:

a. Piercing spike
b. Drop orifice
c. Drip chamber
d. Roller clamp
e. Y-injection site / port – direct injection to the blood vessel
f. Luer-Lock site

Volume Control Set – patients at risk with circulatory overload (e.g. infants)

- controls the volume of solution that goes through / the amount of medication you
give to the patient
Location:

Adult

- Use Peripheral, Superficial veins

- Metacarpal veins – dorsal aspect of hand

- Cephalic veins – in line with thumb

- Basilic veins – ulnar side

- Median Cubita vein – vein that crosses in the cubital region

- Great Saphenous vein

- Dorsal venous network

- Frontal

- Superficial temporal

- Occipital

Children

- Great Saphenous vein

- Dorsal venous network

Infant

- Frontal

- Superficial Temporal

- Occipital

Factors Affecting Rate of Flow

1. Pressure gradient – the difference between two levels in a fluid system

2. Friction – the interaction between fluid molecules & surfaces of inner wall of tubing
3. Diameter & Length of tubing, gauge of cannula
4. Height of infusion container – ideal height is 36” or 3 ft. from insertion site
5. Size of opening through which fluid leaves receptacle
 6. Characteristic of fluid
a. Viscosity
b. Temperature – refrigerated fluids may cause diminished flow & venous spasm

Intervention: Administer fluid at room temperature

7. Vein trauma, clots, plugging of veins, venous spasm

a. Vasoconstriction – result from anxiety; cold IV fluids; sever vein irritation from
irritating drugs or fluids
8. Flow control clamp derangement

a. Some clamps may slip & loosen resulting in rapid or “runaway” infusion
b. Plastic tubing may distort causing “creep” or “cold flow”
c. Marked stretching of tubing may cause distortion of tubing & render clamp
ineffective (may occur when patient turns over & pull on the short tubing).
9. Manipulation of the clamp by the patient or significant others

April 23, 2005

How To Terminate IV Therapy:

1. Check the doctor’s order for IV termination

2. Wash hands
3. Prepare the equipment needed

- plaster

- cotton balls (3 wet, 3 dry)

- bandage scissors

- waste receptacle

4. Explain procedure to the client

5. Clamp the IV line
6. Put on gloves as necessary
7. Lift the tape from skin to expose the insertion site using wet cotton balls
8. Apply dry cotton ball directly over the insertion site. Using the other hand, quickly
remove the device and tape from the skin
9. Maintain direct pressure on the IV site for 1 to 2 minutes
10. Put plaster over the insertion site, hold limb upright for 5 minutes
11. Instruct patient to restrict activity for about 10 minutes and leave the site with a plaster
in place for at least 8 hours as necessary
12. Dispose used venipuncture device, tubing and solution containers in their designated
garbage bin, according to agency policy.